Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial

Background Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population. Methods AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921. Findings Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [<1%]; p=0·038) at 6 months. Interpretation Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke

A Two-Dimensional Simulation of Flow Field in Lakes under Wind Acting on the Water Surface and the Impact of Aquatic Plants on the Flow Patterns

Circulation in lakes, which is primarly caused by wind shear acting on the water surface, is one of the key issues in the field of water environment. Therefore, simulating wind-induced flows in lakes is great of significance. The objective of this research is to build a two-dimensional, unsteady, katerally averaged model for simulating field in lakes. The main foundation of the model is the incompressible Navier-Stokes equations for two dimensions laterallr and vertically. In this research, these equations were discretized by the infinite volume method (FVM), and were solved for flow field velocities by the SIMPLE (Semi-Implit Method for Pressure-Linked Equations) algorithm (Patanlar, 1980) with the variables defined on a space- staggered grid. To solve these equations effectively, a numeral method has been developed by using the Tri-Diagonal Matrix Algorithm (TDMA), and software program has been coded in Fortran 90 (Nyhoff and Leedtma, 1997;1999) to implement the algorithm. To vertify the model, Tabiishidani lake was chosen as a case study. Tobiishidani lake\u27s cross-section size and meteorologocal data were observed and used as the boundary conditions for the model. After coding, the model was used to simulate the wind-induced flow patterns in the lake under the different areas covered by aquatic plants on the water durface

A Two-Dimensional Model for Water Quality Simulation in lakes and its Aplication to Tabiishidani Lake in Sasaguri : Fukuoka Prefecture,Japan

The objective of the research is to ubild a two-domensional, unsteady, laterally averaged model for simulating water quality in lakes. The model consists of circulation of flow fields and water quality simulation in lakes. The main foundation of the model is two-dimensional equations of the incompressible Navier-Stokes equations simulation and diffusion equations for water quality simulation. These equations were doscretized by the finite volume method(FVM) and were solved for flow field velocities and water quality variables respectively by the SIMPLE(Semi-Implit Method for Pressure-Linked Equations) algorithm (Patanlar, 1980) with the variables defined on a space- staggered grid. To solve these equations effectively, a numeral method has been developed and coded in Fortran 90 (Nyhoff and Leedtma, 1997;1999) with using the Tri-Diagonal Matrix Algorithm (TDMA). To vertify the model, Tabiishidani lake, which is water temperature, the size of cross-sections of the lake and meteorological data have been collected and used as the initial and boundary conditions for the model. After calibration, the model was applied to simulate water temperature was chosen to illustrate the mothodology. Howecer, this model can be extended to simulate any variable of water quality in lakes. The results of this research indicate that this model can be a useful tool for simulating water quality in lakes